Palliative Care on Med Surg Floor

[Tgeagle83]

Hey all,

I work in an incredibly understaffed hospital with administrators constantly trying to cut cost. Currently my unit (post-op/orthopedic/medsurg/telemetry) is accepting palliative care patients too so that the hospital won't have to consult hospice. Last night along with the rest of my team and NO aid I took care of this actively dying apneic patient and was in there every hour or more. This morning I got word that our DON wants us to use PCA pumps for these patients and the nurse can come in and hit the button or just do a continuous rate to help with the acuity and us being stretched thin. The doctor was writing the order after I finished handing off report. IS THIS EVEN LEGAL?!?!?

[Here.I.Stand, BSN, RN]

Why would performing palliative care be illegal? Pain med infusions are a good option for someone whose pain needs such frequent intervention. I'm an ICU nurse, and if pts are still alive a few hrs after withdrawing aggressive care we transfer them to one of our non-monitored med/surg floors. It's quieter for them, and the ICU bed is freed up. When I was a floor nurse, we would have comfort care pts on continuous morphine fairly frequently too.

[Tgeagle83]

But on a pain pump?? That's my question. Can someone that cannot push their own PCA button, have a PCA?

[RainMom]

Yes, it is not uncommon for our palliative or inpt hospice pts on the floor to have a pca with a continuous rate. Better comfort for pt & less IVP for the nurse. The PCA can be set up without the pt control option with orders for a prn bolus dose.

[Julius Seizure]

Its not "technically" a PCA anymore (since that means "patient controlled analgesia"), but yes you can have a "nurse controlled analgesia" pump as an appropriate method of pain management. In general, it still gets called a PCA.

[Here.I.Stand, BSN, RN]

But on a pain pump?? That's my question. Can someone that cannot push their own PCA button, have a PCA?

The MD should order "continuous" and/or "clinician bolus." Same PCA pump is used, but instead of the button with the cord, the nurse programs it into the pump after entering the security code. I do see what you're saying about pushing the *PCA* button since we're not supposed to. But if the dr orders *clinician bolus,* again you're A-OK.

The order can have up to 3 components: continuous/basal rate, demand dose which is the patient controlled part, and clinician bolus. In this case, the dr would omit the demand doses

[Julius Seizure]

The MD should order "continuous" and/or "clinician bolus." Same PCA pump is used, but instead of the button with the cord, the nurse programs it into the pump after entering the security code. I do see what you're saying about pushing the *PCA* button since we're not supposed to. But if the dr orders *clinician bolus,* again you're A-OK.

The order can have up to 3 components: continuous/basal rate, demand dose which is the patient controlled part, and clinician bolus. In this case, the dr would omit the demand doses

Ooh you get all fancy. We just put the button.

[BSN16]

But on a pain pump?? That's my question. Can someone that cannot push their own PCA button, have a PCA?

Yes, but usually it is set at a continues rate and the RN is able to bolus if written in the order.

[foggnm]

Yes, you can use a PCA with a basal rate and the nurse can administer bolus doses if the orders reflect it. Or alternately they can do a continuous pca with IV boluses by the nurse. The PCA just makes it more convenient. It is quite legal and quite safe for your license. But your med surg floor probably has a pharmacy policy on what drugs can/not be used and how. And usually those policies are stricter on med surg floors (vs ICU) because of the higher nursing ratio.

[FurBabyMom, MSN, RN]

Yes, it is not uncommon for our palliative or inpt hospice pts on the floor to have a pca with a continuous rate. Better comfort for pt & less IVP for the nurse. The PCA can be set up without the pt control option with orders for a prn bolus dose.

We did this sometimes when I worked the floor.

[Daisy4RN]

Yes, this is common for dying/hospice/palliative patient's to have a continuous PCA running. This is actually a good practice because it gives the patient the best pain control. Just make sure that you educate the patient and family regarding use and document the education, esp that the family is not to push the button. If the pain is not controlled all the time the nurse can give extra bolus prn.

[Here.I.Stand, BSN, RN]

Ooh you get all fancy. We just put the button.

Yeah that's one of our firm policies -- staff and family are not to press the button. Maybe we'll shoot out of orbit and crash into Jupiter if we do?

Also though, lots of times the drs order a dose range for clinician boluses. That's quicker than reprogramming the pump every time we adjust the dose